Procedure Code	Procedure Description	Pricing Indicator	Rate Type	Mod1	Mod2	Mod3	Mod4	Max Fee	Max Fee Eff. Date	Max Fee End Date	PA
DD121	COMM RESPITE PART DAY NO MOD	MAXFEE	WVR					52.65	1/1/2022	12/31/2299	N
DD122	COMM RESPITE PARTIAL DAY MED	MAXFEE	WVR					55.65	1/1/2022	12/31/2299	N
DD123	COMM RESPITE PARTIAL DAY BEHAV	MAXFEE	WVR					68.40	1/1/2022	12/31/2299	N
DD124	COMM RESPITE PART DAY MED/BEHA	MAXFEE	WVR					71.40	1/1/2022	12/31/2299	N
DD125	COMM RESPITE 15 MIN NO MOD	MAXFEE	WVR					2.11	1/1/2022	12/31/2299	N
DD126	COMM RESPITE 15 MIN MED ADD-ON	MAXFEE	WVR					2.23	1/1/2022	12/31/2299	N
DD127	COMM RESPITE 15 MIN BEHAV	MAXFEE	WVR					2.74	1/1/2022	12/31/2299	N
DD128	COMM RESPITE 15 MIN MED/BEHAV	MAXFEE	WVR					2.86	1/1/2022	12/31/2299	N
DD129	COMM RESPITE FULL DAY NO MOD	MAXFEE	WVR					175.83	1/1/2022	12/31/2299	N
DD130	COMM RESPITE FULL DAY MED	MAXFEE	WVR					183.78	1/1/2022	12/31/2299	N
DD131	COMM RESPITE FULL DAY BEHAV	MAXFEE	WVR					216.15	1/1/2022	12/31/2299	N
DD132	COMM RESPITE FULL DAY BEHA/MED	MAXFEE	WVR					223.83	1/1/2022	12/31/2299	N
DD133	RESIDENTIAL RESPITE RESID. DAY	MAXFEE	WVR					143.31	1/1/2022	12/31/2299	N
DD134	RESIDENTIAL RESPITE RESID. DAY	MAXFEE	WVR					143.31	1/1/2022	12/31/2299	N
DD135	RESIDENTIAL RESPITE ICF/DD DAY	MAXFEE	WVR					220.48	1/1/2022	12/31/2299	N
DD136	RESIDENT RESPITE ICF/DD EMER	MAXFEE	WVR					220.48	1/1/2022	12/31/2299	N
DD137	RESIDENT RESPITE LIC FAC DAY	MAXFEE	WVR					143.31	1/1/2022	12/31/2299	N
DD138	RESIDENT RESPITE LIC FAC EMER	MAXFEE	WVR					143.31	1/1/2022	12/31/2299	N
DD139	REMOTE MONITORING UNPAID -HR	MAXFEE	WVR					6.88	1/1/2019	12/31/2299	N
DD140	REMOTE MONITORING UNPD-EMER HR	MAXFEE	WVR					6.88	1/1/2019	12/31/2299	N
DD141	REMOTE MONITORING PAID - HR	MAXFEE	WVR					10.24	1/1/2019	12/31/2299	N
DD142	REMOTE MONITORING PAID-EMER HR	MAXFEE	WVR					10.24	1/1/2019	12/31/2299	N
DD145	HOME DELIVERED MEALS	MAXFEE	WVR					8.68	7/1/2022	12/31/2299	N
DD146	INFORMAL RESPITE 15 MIN EMER	MAXFEE	WVR					2.86	1/1/2022	12/31/2299	N
DD163	CP-BENEFITS ED & ANAYL L1; 1 UNIT	MAXFEE	WVR					334.08	1/1/2022	12/31/2299	N
DD164	CP-CAREER DISC GRP A & A-1 L1; 1 UNIT	MAXFEE	WVR					1127.57	1/1/2022	12/31/2299	N
DD165	CP-CAREER DISCOVERY GROUP B L1; 1 UNIT	MAXFEE	WVR					1691.35	1/1/2022	12/31/2299	N
DD166	CP-CAREER DISCOVERY GROUP C L1; 1 UNIT	MAXFEE	WVR					2255.14	1/1/2022	12/31/2299	N
DD167	CP-CAREER EXPLRTN AGNCY L1; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD168	CP-CAREER EXPLRTN INDP L1; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD168	CP-CAREER EXPLRTN INDP L1; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD169	CP-SELF EMPLOYMENT PLAN L1; 1 UNIT	MAXFEE	WVR					845.68	1/1/2022	12/31/2299	N
DD170	CP-JOB DEVELPMENT AGENCY L1; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD171	CP-JOB DEVELPMNT INDPL1; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD171	CP-JOB DEVELPMNT INDPL1; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD172	CP-EMPLYMT LAUNCH AGNCY L1; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD173	CP-EMPLYMNT LAUNCH INDP L1; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD173	CP-EMPLYMNT LAUNCH INDP L1; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD174	CP-SITUATIONAL OB & ASSESSMNT L1; 1 UNIT	MAXFEE	WVR					845.68	1/1/2022	12/31/2299	N
DD175	CP-WRKSITE ACCESS AGNCY L1; 15 MIN UNIT	MAXFEE	WVR					14.84	1/1/2022	12/31/2299	N
DD176	CP-WRKSITE ACCESS INDP L1; 15 MIN UNIT	MAXFEE	WVR					9.59	1/1/2022	12/31/2299	N
DD176	CP-WRKSITE ACCESS INDP L1; 15 MIN UNIT	MAXFEE	OVR					12.26	1/1/2022	12/31/2299	N
DD194	IND EMPLYMNT SUPPT L1 AGNCY; 15 MIN UNIT	MAXFEE	WVR					12.15	1/1/2022	12/31/2299	N
DD195	IND EMPLYMNT SUPPT L1 INDP; 15 MIN UNIT	MAXFEE	WVR					7.90	1/1/2022	12/31/2299	N
DD195	IND EMPLYMNT SUPPT L1 INDP; 15 MIN UNIT	MAXFEE	OVR					10.14	1/1/2022	12/31/2299	N
DD202	GRP EMPL SUPPORT L1 GRP A; 15 MIN UNIT	MAXFEE	WVR					2.29	1/1/2022	12/31/2299	N
DD203	GRP EMPL SUPPORT L1 GRP A-1; 15 MIN UNIT	MAXFEE	WVR					1.91	1/1/2022	12/31/2299	N
DD204	GRP EMPL SUPPORT L1 GRP B; 15 MIN UNIT	MAXFEE	WVR					3.52	1/1/2022	12/31/2299	N
DD205	GRP EMPL SUPPORT L1 GRP C; 15 MIN UNIT	MAXFEE	WVR					5.58	1/1/2022	12/31/2299	N
DD220	MONEY MANAGEMENT-L1 AGNCY; 15 MIN UNIT	MAXFEE	WVR					5.20	4/1/2017	12/31/2299	N
DD221	MONEY MANAGEMENT-L1 INDP; 15 MIN UNIT	MAXFEE	WVR					4.49	4/1/2017	12/31/2299	N
DD221	MONEY MANAGEMENT-L1 INDP; 15 MIN UNIT	MAXFEE	OVR					5.94	4/1/2017	12/31/2299	N
DD228	GROUP EMPLOYMENT SUPPORT L1 GRP A; DAILY	MAXFEE	WVR					38.50	1/1/2022	12/31/2299	N
DD229	GROUP EMPLOYMENT SUPPORT L1 GRP A-1; DAY	MAXFEE	WVR					29	1/1/2022	12/31/2299	N
DD230	GROUP EMPLOYMENT SUPPORT L1 GRP B; DAILY	MAXFEE	WVR					69.25	1/1/2022	12/31/2299	N
DD231	GROUP EMPLOYMENT SUPPORT L1 GRP C; DAILY	MAXFEE	WVR					115.75	1/1/2022	12/31/2299	N
DD240	L1W PART/DIR HPC; 15 MINUTE UNIT	MAXFEE	WVR					7.81	1/1/2022	12/31/2299	N
DD240	L1W PART/DIR HPC; 15 MINUTE UNIT	MAXFEE	OVR					10.75	1/1/2022	12/31/2299	N
DD241	L1W PART/DIR OSOC HPC; 15 MINUTE UNIT	MAXFEE	WVR					3.66	1/1/2022	12/31/2299	N
DD241	L1W PART/DIR OSOC HPC; 15 MINUTE UNIT	MAXFEE	OVR					5.49	1/1/2022	12/31/2299	N
DD242	L1WE PART/DIR. HPC; 15 MINUTE UNIT	MAXFEE	WVR					7.81	1/1/2022	12/31/2299	N
DD242	L1WE PART/DIR. HPC; 15 MINUTE UNIT	MAXFEE	OVR					10.75	1/1/2022	12/31/2299	N
DD243	L1WE PART/DIR. OSOC HPC; 15 MINUTE UNIT	MAXFEE	WVR					3.66	1/1/2022	12/31/2299	N
DD243	L1WE PART/DIR. OSOC HPC; 15 MINUTE UNIT	MAXFEE	OVR					5.49	1/1/2022	12/31/2299	N
DD255	L1W COMP BASED HMKR PERS CARE; 15 MIN	MAXFEE	WVR					8.57	1/1/2022	12/31/2299	N
DD255	L1W COMP BASED HMKR PERS CARE; 15 MIN	MAXFEE	OVR					9.61	1/1/2022	12/31/2299	N
DD256	L1W COMP BASED HPC-STAFF 2;15 MIN	MAXFEE	WVR					15.24	1/1/2022	12/31/2299	N
DD257	L1W COMP BASED HPC-STAFF 3;15 MIN	MAXFEE	WVR					21.92	1/1/2022	12/31/2299	N
DD258	L1W COMP BASED HPC-STAFF 4;15 MIN	MAXFEE	WVR					28.58	1/1/2022	12/31/2299	N
DD259	L1W COMP BASED HPC-STAFF 5;15 MIN	MAXFEE	WVR					35.26	1/1/2022	12/31/2299	N
DD260	L1WE COMP BASED HMKR PERS CARE; 15 MIN	MAXFEE	WVR					8.57	1/1/2022	12/31/2299	N
DD260	L1WE COMP BASED HMKR PERS CARE; 15 MIN	MAXFEE	OVR					9.61	1/1/2022	12/31/2299	N
DD261	L1WE COMP BASED HPC-STAFF 2;15 MIN	MAXFEE	WVR					15.24	1/1/2022	12/31/2299	N
DD262	L1WE COMP BASED HPC-STAFF 3;15 MIN	MAXFEE	WVR					21.92	1/1/2022	12/31/2299	N
DD263	L1WE COMP BASED HPC-STAFF 4;15 MIN	MAXFEE	WVR					28.58	1/1/2022	12/31/2299	N
DD264	L1WE COMP BASED HPC-STAFF 5;15 MIN	MAXFEE	WVR					35.26	1/1/2022	12/31/2299	N
DD269	LV1-ASSISTIVE TECHNOLOGY CONSULTATION	MAXFEE	WVR					137.44	1/1/2019	12/31/2299	N
DD270	LV1E-ASSISTIVE TECH CONSULTATION-ER	MAXFEE	WVR					137.44	1/1/2019	12/31/2299	N
DD271	LV1-ASSISTIVE TECHNOLOGY EQUIPMENT	MAXFEE	WVR					5000	1/1/2019	12/31/2299	N
DD272	LV1E-ASSISTIVE TECHNOLOGY EQUIPMENT-ER	MAXFEE	WVR					8520	1/1/2019	12/31/2299	N
DD273	LV1-ASSISTIVE TECHNOLOGY SUPPORT	MAXFEE	WVR					5.45	1/1/2019	12/31/2299	N
DD274	LV1E-ASSISTIVE TECHNOLOGY SUPPORT-ER	MAXFEE	WVR					5.45	1/1/2019	12/31/2299	N
DD290	L1 - BEST DAY UNIT - A1	MAXFEE	WVR					NA			N
DD291	L1 - BEST DAY UNIT - A	MAXFEE	WVR					NA			N
DD292	L1 - BEST DAY UNIT - B	MAXFEE	WVR					NA			N
DD293	L1 - BEST DAY UNIT - C	MAXFEE	WVR					NA			N
DD294	L1 - BEST 15 MINUTE UNIT - A1	MAXFEE	WVR					NA			N
DD295	L1 - BEST 15 MINUTE UNIT - A	MAXFEE	WVR					NA			N
DD296	L1 - BEST 15 MINUTE UNIT - B	MAXFEE	WVR					NA			N
DD297	L1 - BEST 15 MINUTE UNIT - C	MAXFEE	WVR					NA			N
DD298	L1 - BEST 15 MIN UNIT WITH INT - A1	MAXFEE	WVR					NA			N
DD299	L1 - BEST 15 MIN UNIT WITH INT - A	MAXFEE	WVR					NA			N
DD300	L1 - BEST 15 MIN UNIT WITH INT - B	MAXFEE	WVR					NA			N
DD301	L1 - BEST 15 MIN UNIT WITH INT - C	MAXFEE	WVR					NA			N
DD318	LV1 - SELF DIRECTED TRANSPORTATION-ITEM	MAXFEE	WVR					104	7/1/2022	12/31/2299	N
DD319	LV1 - SLF DIR TRANS - MILE - MOD VEH	MAXFEE	WVR					1.04	7/1/2022	12/31/2299	N
DD320	LV1 - SLF DIR TRANS - MILE - NON MOD VEH	MAXFEE	WVR					0.60	7/1/2022	12/31/2299	N
DD321	LV1 - SELF DIRECTED TRANSPORTATION-TRIP	MAXFEE	WVR					104	7/1/2022	12/31/2299	N
DD328	L1 - PARTICIPANT DIRECTED GOODS & SVCS	MAXFEE	WVR					2500	7/1/2022	12/31/2299	N
DD329	L1 - FUNCTIONAL BEHAVIORAL ASSESSMENT	MAXFEE	WVR					1500	7/1/2022	12/31/2299	N
DD330	L1 - CLINICAL/THERAP INTERVEN - INDEP	MAXFEE	WVR					21.32	7/1/2022	12/31/2299	N
DD331	L1 - CLINICAL/THERAP INTERV - AGENCY	MAXFEE	WVR					32.19	7/1/2022	12/31/2299	N
DD332	L1 - SPECIAL CLNC/THERA INTERVEN - INDEP	MAXFEE	WVR					50.76	7/1/2022	12/31/2299	N
DD333	L1 - SPECIAL CLNC/THERA INTERVEN - AGNCY	MAXFEE	WVR					68.91	7/1/2022	12/31/2299	N
DD334	L1 - SR-LVL CLINC/THERA INTERVEN - INDEP	MAXFEE	WVR					90.65	7/1/2022	12/31/2299	N
DD335	L1 - SR-LVL CLINC/THERA INTERVEN - AGNCY	MAXFEE	WVR					123.06	7/1/2022	12/31/2299	N
DD336	L1 - PART/FAMLY STABILITY ASSIST - INDEP	MAXFEE	WVR					1000	7/1/2022	12/31/2299	N
DD337	L1 - PART/FAMLY STABILITY ASSIST - AGNCY	MAXFEE	WVR					1000	7/1/2022	12/31/2299	N
MR009	ADULT DAY SUPPT-L1 GROUP A-1; 15 MINUTE	MAXFEE	WVR					2.59	1/1/2022	12/31/2299	N
MR010	ADULT DAY SUPPT-L1 GROUP A; 15 MINUTE	MAXFEE	WVR					3.03	1/1/2022	12/31/2299	N
MR011	ADULT DAY SUPPT-L1 GROUP B; 15 MINUTE	MAXFEE	WVR					4.44	1/1/2022	12/31/2299	N
MR012	ADULT DAY SUPPT-L1 GROUP C; 15 MINUTE	MAXFEE	WVR					6.55	1/1/2022	12/31/2299	N
MR013	ADULT DAY SUPPT-L1 GROUP A-1; DAILY	MAXFEE	WVR					51.75	1/1/2022	12/31/2299	N
MR014	ADULT DAY SUPPT-L1 GROUP A; DAILY	MAXFEE	WVR					62.75	1/1/2022	12/31/2299	N
MR015	ADULT DAY SUPPT-L1 GROUP B; DAILY	MAXFEE	WVR					98	1/1/2022	12/31/2299	N
MR016	ADULT DAY SUPPT-L1 GROUP C; DAILY	MAXFEE	WVR					150.75	1/1/2022	12/31/2299	N
MR025	VOC.HAB.-L1 GROUP A-1; 15 MINUTE UNIT	MAXFEE	WVR					2.59	1/1/2022	12/31/2299	N
MR026	VOC.HAB.-L1 GROUP A; 15 MINUTE UNIT	MAXFEE	WVR					3.03	1/1/2022	12/31/2299	N
MR027	VOC.HAB.-L1 GROUP B; 15 MINUTE UNIT	MAXFEE	WVR					4.44	1/1/2022	12/31/2299	N
MR028	VOC.HAB.-L1 GROUP C; 15 MINUTE UNIT	MAXFEE	WVR					6.55	1/1/2022	12/31/2299	N
MR029	VOC. HAB.-L1 GROUP A-1; DAILY	MAXFEE	WVR					51.75	1/1/2022	12/31/2299	N
MR030	VOC. HAB.-L1 GROUP A; DAILY	MAXFEE	WVR					62.75	1/1/2022	12/31/2299	N
MR031	VOC. HAB.-L1 GROUP B; DAILY	MAXFEE	WVR					98	1/1/2022	12/31/2299	N
MR032	VOC. HAB.-L1 GROUP C; DAILY	MAXFEE	WVR					150.75	1/1/2022	12/31/2299	N
MR068	NON-MEDICAL TRANSPO.; L1 PER MILE	MAXFEE	OTH					1.04	1/1/2022	12/31/2299	N
MR068	NON-MEDICAL TRANSPO.; L1 PER MILE	MAXFEE	WVR					0.60	1/1/2022	12/31/2299	N
MR070	NON-MEDICAL TRANSPO.; 1 PER TRIP	MAXFEE	WVR					20.89	1/1/2022	12/31/2299	N
MR076	NON-MEDICAL TRANS TAXI-LIVERY-BUS L1 WVR	MAXFEE	WVR					104	1/1/2022	12/31/2299	N
MR820	L1W HPC-STAFF 2;15 MIN UNIT	MAXFEE	WVR					14.46	1/1/2022	12/31/2299	N
MR821	L1W HPC-STAFF 3;15 MIN UNIT	MAXFEE	WVR					20.75	1/1/2022	12/31/2299	N
MR822	L1W HPC-STAFF 4;15 MIN UNIT	MAXFEE	WVR					27.02	1/1/2022	12/31/2299	N
MR823	L1W HPC-STAFF 5;15 MIN UNIT	MAXFEE	WVR					33.31	1/1/2022	12/31/2299	N
MR824	L1WE HPC-STAFF 2;15 MINUTE UNIT	MAXFEE	WVR					14.46	1/1/2022	12/31/2299	N
MR825	L1WE HPC-STAFF 3;15 MINUTE UNIT	MAXFEE	WVR					20.75	1/1/2022	12/31/2299	N
MR826	L1WE HPC-STAFF 4;15 MINUTE UNIT	MAXFEE	WVR					27.02	1/1/2022	12/31/2299	N
MR827	L1WE HPC-STAFF 5;15 MINUTE UNIT	MAXFEE	WVR					33.31	1/1/2022	12/31/2299	N
MR836	L1W HPC-OS/OC-STAFF 2; 15 MIN UNIT	MAXFEE	WVR					8.59	1/1/2022	12/31/2299	N
MR837	L1W HPC-OS/OC-STAFF 3; 15 MIN UNIT	MAXFEE	WVR					12.89	1/1/2022	12/31/2299	N
MR838	L1W HPC-OS/OC-STAFF 4; 15 MIN UNIT	MAXFEE	WVR					17.18	1/1/2022	12/31/2299	N
MR839	L1W HPC-OS/OC-STAFF 5; 15 MIN UNIT	MAXFEE	WVR					21.47	1/1/2022	12/31/2299	N
MR840	L1WE HPC-OS/OC-STAFF 2;15 MINUTE UNIT	MAXFEE	WVR					8.59	1/1/2022	12/31/2299	N
MR841	L1WE HPC-OS/OC-STAFF 3;15 MINUTE UNIT	MAXFEE	WVR					12.89	1/1/2022	12/31/2299	N
MR842	L1WE HPC-OS/OC-STAFF 4;15 MINUTE UNIT	MAXFEE	WVR					17.18	1/1/2022	12/31/2299	N
MR843	L1WE HPC-OS/OC-STAFF 5;15 MINUTE UNIT	MAXFEE	WVR					21.47	1/1/2022	12/31/2299	N
MR970	L1W HMKR PERS CARE; 15 MINUTE UNIT	MAXFEE	WVR					8.18	1/1/2022	12/31/2299	N
MR970	L1W HMKR PERS CARE; 15 MINUTE UNIT	MAXFEE	OVR					9.22	1/1/2022	12/31/2299	N
MR971	L1W TRANSPORTATION; 1 MILE UNIT	MAXFEE	OTH					1.04	1/1/2022	12/31/2299	N
MR971	L1W TRANSPORTATION; 1 MILE UNIT	MAXFEE	WVR					0.60	1/1/2022	12/31/2299	N
MR972	L1W INFORMAL RESPITE; 15 MINUTE UNIT	MAXFEE	WVR					2.86	1/1/2022	12/31/2299	N
MR975	L1W ENVIRON ACCESS ADAPT; 1 ITEM	MAXFEE	WVR					7500	9/1/2013	12/31/2299	N
MR976	L1W SPEC MED EQUIP & SUPP; 1 ITEM	MAXFEE	WVR					7500	9/1/2013	12/31/2299	N
MR979	L1W HMKR PERS CARE-OS/OC; 15 MINUTE UNIT	MAXFEE	WVR					4.29	1/1/2022	12/31/2299	N
MR979	L1W HMKR PERS CARE-OS/OC; 15 MINUTE UNIT	MAXFEE	OVR					6.16	1/1/2022	12/31/2299	N
MR980	L1WE HMKR PERS CARE; 15 MINUTE UNIT	MAXFEE	WVR					8.18	1/1/2022	12/31/2299	N
MR980	L1WE HMKR PERS CARE; 15 MINUTE UNIT	MAXFEE	OVR					9.22	1/1/2022	12/31/2299	N
MR981	L1WE TRANSPORTATION; 1 MILE UNIT	MAXFEE	OTH					1.04	1/1/2022	12/31/2299	N
MR981	L1WE TRANSPORTATION; 1 MILE UNIT	MAXFEE	WVR					0.60	1/1/2022	12/31/2299	N
MR985	L1WE ENVIRON ACCESS ADAPT; 1 ITEM	MAXFEE	WVR					8000	9/1/2013	12/31/2299	N
MR986	L1WE SPEC MED EQUIP & SUPP; 1 ITEM	MAXFEE	WVR					8520	1/1/2016	12/31/2299	N
MR989	L1WE HMKR PERS CARE-OS/OC;15 MINUTE UNIT	MAXFEE	WVR					5.67	1/1/2022	12/31/2299	N
MR989	L1WE HMKR PERS CARE-OS/OC;15 MINUTE UNIT	MAXFEE	OVR					6.16	1/1/2022	12/31/2299	N